Basic Information
| Provider Information | |||||||||
| NPI: | 1841519279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIEDMANN | ||||||||
| FirstName: | CLAIRE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MUNRO | ||||||||
| OtherFirstName: | CLAIRE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 341 10TH AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ROYERSFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194683807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107928100 | ||||||||
| FaxNumber: | 6107921535 | ||||||||
| Practice Location | |||||||||
| Address1: | 341 10TH AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ROYERSFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194683807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107928100 | ||||||||
| FaxNumber: | 6107921535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2010 | ||||||||
| LastUpdateDate: | 05/25/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | PT011395L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.